Provider Demographics
NPI:1801858907
Name:GUSHIN, LOIS ISAACS (MS)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:ISAACS
Last Name:GUSHIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:LOIS
Other - Middle Name:E
Other - Last Name:ISAACS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:1858 SOLUTIONS CTR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1008
Mailing Address - Country:US
Mailing Address - Phone:513-891-2813
Mailing Address - Fax:513-793-1032
Practice Address - Street 1:2825 BURNET AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2426
Practice Address - Country:US
Practice Address - Phone:513-221-0527
Practice Address - Fax:513-221-1703
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA00406231H00000X
OHA 00406237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00415883OtherRR MEDICARE
OH4083641Medicare PIN